Bradi B Granger1, James A Tulsky2, Brystana G Kaufman3, Robert M Clare4, Kevin Anstrom4, Daniel B Mark5, Kimberly A Johnson6, Chetan B Patel6, Mona Fiuzat6, Karen Steinhauser7, Christopher O'connor6, Joseph G Rogers8, Robert J Mentz9. 1. School of Nursing, Duke University, Durham, North Carolina; Margolis Center for Health Policy, Duke University, Durham, North Carolina. Electronic address: bradi.granger@dm.duke.edu. 2. Dana-Farber Institute, Harvard Medical School, Boston, Massachusetts; Brigham and Women's Hospital, Boston, Massachusetts. 3. Margolis Center for Health Policy, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina. 4. Duke Clinical Research Institute, Durham, North Carolina. 5. Duke Clinical Research Institute, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina. 6. Department of Medicine, Duke University School of Medicine, Durham, North Carolina. 7. Margolis Center for Health Policy, Duke University, Durham, North Carolina. 8. Texas Heart Institute, Houston, Texas. 9. Department of Medicine, Duke University School of Medicine, Durham, North Carolina; Texas Heart Institute, Houston, Texas.
Abstract
BACKGROUND: Palliative care (PC) in advanced heart failure (HF) aims to improve symptoms and quality of life (QOL), in part through medication management. The impact of PC on polypharmacy (>5 medications) remains unknown. METHODS AND RESULTS: We explored patterns of polypharmacy in the Palliative Care in HF (PAL-HF) randomized controlled trial of standard care vs interdisciplinary PC in advanced HF (N = 150). We describe differences in medication counts between arms at 2, 6, 12, and 24 weeks for HF (12 classes) and PC (6 classes) medications. General linear mixed models were used to evaluate associations between treatment arm and polypharmacy over time. The median age of the patients was 72 years (interquartile range 62-80 years), 47% were female, and 41% were Black. Overall, 48% had ischemic etiology, and 55% had an ejection fraction of 40% or less. Polypharmacy was present at baseline in 100% of patients. HF and PC medication counts increased in both arms, with no significant differences in counts by drug class at any time point between arms. CONCLUSIONS: In a trial of patients with advanced HF considered eligible for PC, polypharmacy was universal at baseline and increased during follow-up with no effect of the palliative intervention on medication counts relative to standard care.
BACKGROUND: Palliative care (PC) in advanced heart failure (HF) aims to improve symptoms and quality of life (QOL), in part through medication management. The impact of PC on polypharmacy (>5 medications) remains unknown. METHODS AND RESULTS: We explored patterns of polypharmacy in the Palliative Care in HF (PAL-HF) randomized controlled trial of standard care vs interdisciplinary PC in advanced HF (N = 150). We describe differences in medication counts between arms at 2, 6, 12, and 24 weeks for HF (12 classes) and PC (6 classes) medications. General linear mixed models were used to evaluate associations between treatment arm and polypharmacy over time. The median age of the patients was 72 years (interquartile range 62-80 years), 47% were female, and 41% were Black. Overall, 48% had ischemic etiology, and 55% had an ejection fraction of 40% or less. Polypharmacy was present at baseline in 100% of patients. HF and PC medication counts increased in both arms, with no significant differences in counts by drug class at any time point between arms. CONCLUSIONS: In a trial of patients with advanced HF considered eligible for PC, polypharmacy was universal at baseline and increased during follow-up with no effect of the palliative intervention on medication counts relative to standard care.
Authors: Larry A Allen; Gregg C Fonarow; Li Liang; Phillip J Schulte; Frederick A Masoudi; John S Rumsfeld; P Michael Ho; Zubin J Eapen; Adrian F Hernandez; Paul A Heidenreich; Deepak L Bhatt; Eric D Peterson; Harlan M Krumholz Journal: Circulation Date: 2015-08-27 Impact factor: 29.690
Authors: Joseph G Rogers; Chetan B Patel; Robert J Mentz; Bradi B Granger; Karen E Steinhauser; Mona Fiuzat; Patricia A Adams; Adam Speck; Kimberly S Johnson; Arun Krishnamoorthy; Hongqiu Yang; Kevin J Anstrom; Gwen C Dodson; Donald H Taylor; Jerry L Kirchner; Daniel B Mark; Christopher M O'Connor; James A Tulsky Journal: J Am Coll Cardiol Date: 2017-07-18 Impact factor: 24.094
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Authors: Ozan Unlu; Emily B Levitan; Evgeniya Reshetnyak; Jerard Kneifati-Hayek; Ivan Diaz; Alexi Archambault; Ligong Chen; Joseph T Hanlon; Mathew S Maurer; Monika M Safford; Mark S Lachs; Parag Goyal Journal: Circ Heart Fail Date: 2020-10-13 Impact factor: 8.790